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WAL-MART PHARMACY 10-4681
CH0412810 TAMPA FAMILY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
TAMPA FAMILY HEALTH CENTERS, INC.
Subdivision Name
TFHC #16 New Nebraska
Type
HRSA-Funded Health Center
340B ID
CH0412810
Entity Address
12410 N Nebraska Ave
Tampa, FL 33612
Grant Number
H80CS00407
Participating Start Date
7/1/1995
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4681
Pharmacy Address
4302 W GANDY BLVD
TAMPA, FL 33611
Pharmacy Comments
Contract Details
Approval Date
1/16/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/10/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
Sherry Hoback, Chief Executive Officer
(813) 866-0930 Ext: 1319
Contract Pharmacy Representative
Tampa Family Health Centers, Inc.
Jeffrey Parrado, Chief Pharmacy Officer
(813) 866-0930 Ext: 1363
Signed By Date
1/16/2020
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